Clinical Course and Conservative Strategy for Persistent De Novo Stress Urinary Incontinence After Pelvic Organ Prolapse Repair with Transvaginal Mesh.

<b>Background/Objectives</b>: De novo stress urinary incontinence (SUI) can develop postoperatively in patients without prior symptoms, and can persist beyond 6 months, posing clinical challenges. This study aimed to identify predictors of persistent de novo SUI after transvaginal mesh (TVM) surgery and to evaluate management strategies. <b>Methods</b>: A retrospective review of 817 women with anterior and apical pelvic organ prolapse (POP) (stage II-IV) who underwent TVM surgery from 2013 to 2021 was conducted. Fifty patients developed de novo SUI postoperatively. Assessments included urodynamic studies, validated symptom questionnaires, and POP quantification (POP-Q) staging. Logistic regression analysis was used to identify predictors of persistent symptoms. <b>Results</b>: Spontaneous resolution occurred in 30% (15/50) of participants within six months, while 70% (35/50) had persistent SUI. Concomitant posterior mesh repair was more frequent in the persistent group compared to the self-limiting group (29% vs. 7%), and was significantly associated with symptom persistence (OR 5.6, 95% CI, 0.65-48.4; <i>p</i> = 0.03, chi-square test). During conservative management with observation alone, 30% (15/50) experienced spontaneous resolution within 6 months, while 70% (35/50) had persistent symptoms. Among those with persistent symptoms, 56% required no further treatment, 10% improved with vaginal laser therapy, and 4% underwent sling surgery. <b>Conclusions</b>: Conservative management remains critical in the early postoperative period, given the high rate of spontaneous symptom resolution. For persistent cases, minimally invasive options such as vaginal laser therapy may be beneficial. Notably, only 4% required anti-incontinence surgery.